Complex Collaboration Yields New Quality of Life for Patient


Rebecca Tipton, center, with her doctors, John P. Walker, MD, FACS, and Bilal Farhan, MD.
Rebecca Tipton, center, with her doctors, John P. Walker, MD, FACS, and Bilal Farhan, MD.
Three days before Rebecca Tipton’s scheduled surgery, she had a moment of worry, concerned that the meticulous plan her doctors developed to treat her urinary incontinence would not be successful. A longtime patient of UTMB Health, Tipton knew her case was more complicated than most.

Ms. Tipton, do you trust me? she recalls her urologist, Bilal Farhan, MD, asking over the phone. The answer was easy: she did.

“He reassured me that he had this under control,” she said. “It was one of the toughest times in my life. The personal attention and kindness shown by Dr. Farhan helped me overcome my fears about that very serious surgery.”

Now, many months after her successful surgery, she is emphatic about her appreciation for Dr. Farhan, a female urology, voiding dysfunction and pelvic reconstruction specialist; general surgeon Dr. J. Patrick Walker; and the rest of the team that took care of her.

After her treatment for cervical cancer in 2013, Tipton had undergone an open total abdominal hysterectomy, the removal of her right kidney, a resection of the sigmoid colon (the terminal portion of the large intestine) due to local metastasis, and a fecal diversion colostomy. Following that, she had radiation and chemotherapy; since then she has been cancer-free with regular follow-ups.

Unfortunately, she then developed a stricture, which was treated by a ureteral stent placed between the kidney and bladder to maintain the function of her remaining left kidney. This required attention every three months to be changed under general anesthesia.

Though Tipton was grateful for the lifesaving interventions that had gotten her to this point, her quality of life suffered tremendously. Due to the fibrosis she had developed from radiation, she was experiencing total urinary incontinence.

Her care team at UTMB Health League City recommended she visit Dr. Farhan, who had at that time recently joined UTMB Health as Director of Female Urology, Voiding Dysfunction and Pelvic Reconstruction.

“When Ms. Tipton came to me, she was depending on a diaper five to six times a day. She had chronic pain and (urinary tract infections),” Dr. Farhan said. “I asked her what was her goal, and she said, ‘I just want to be dry and off the ureteral stent, as I have recurrent UTIs and pain.’”

After a full evaluation in the clinic and operating room, the doctors discovered a long segment of stricture – approximately 10 centimeters in the distal ureter, and the bladder was contracted due to the effects of radiation.

From there Dr. Farhan set out to find the best course of action. He consulted with Dr. Walker and minimally invasive surgeon Dr. Richard Lu to explore options that could help Tipton regain her quality of life without compromising her health further.

They looked at two prospective plans and ultimately decided to take an abdominal approach that would release the bowel and divert the urine into a stoma – a procedure known as a urostomy. Most importantly, she would be dry and without a stent.

The surgery took place July 13, 2020 – a day Tipton says she will never forget. With Dr. Farhan concentrating on the diversion of urine and Dr. Walker working to release the bowel, they completed the procedure as successfully as they could have imagined.

“It’s the complexity of the disease that makes this such a success. She is really happy, and her quality of life has gone from the bottom to the top,” Dr. Farhan said.

“I really like taking care of a patient’s quality of life, and the most important thing in treating these conditions is to understand what the patient's expectations are for that treatment,” he added. “I think the best part of my job is really getting to know patients and just being a real part of their life. It's really great to be close and work with them on getting their lives back. I think there's nothing more satisfying than that.”

Tipton is appreciative, and she says that since the surgery, her quality of life – both physically and emotionally – has improved significantly.

“I am just an ordinary patient, but they made me feel like the most important person in the world,” she said.

UTMB Health’s Female Urology program provides full services to women with urinary tract disorders including incontinence and pelvic prolapse surgery.

Urology Service